Lorello Gianni R, Hicks Christopher M, Ahmed Sana-Ara, Unger Zoe, Chandra Deven, Hayter Megan A
*Department of Anaesthesiology and the Li Ka Shing Knowledge Institute,St. Michael's Hospital,University of Toronto,Toronto,ON.
†Department of Emergency Medicine and the Li Ka Shing Knowledge Institute,St. Michael's Hospital,University of Toronto,Toronto,ON.
CJEM. 2016 Mar;18(2):136-42. doi: 10.1017/cem.2015.4. Epub 2015 Apr 10.
Effective trauma resuscitation requires the coordinated efforts of an interdisciplinary team. Mental practice (MP) is defined as the mental rehearsal of activity in the absence of gross muscular movements and has been demonstrated to enhance acquiring technical and procedural skills. The role of MP to promote nontechnical, team-based skills for trauma has yet to be investigated.
We randomized anaesthesiology, emergency medicine, and surgery residents to two-member teams randomly assigned to either an MP or control group. The MP group engaged in 20 minutes of MP, and the control group received 20 minutes of Advanced Trauma Life Support (ATLS) training. All teams then participated in a high-fidelity simulated adult trauma resuscitation and received debriefing on communication, leadership, and teamwork. Two blinded raters independently scored video recordings of the simulated resuscitations using the Mayo High Performance Teamwork Scale (MHPTS), a validated team-based behavioural rating scale. The Mann-Whitney U-test was used to assess for between-group differences.
Seventy-eight residents provided informed written consent and were recruited. The MP group outperformed the control group with significant effect on teamwork behaviour as assessed using the MHPTS: r=0.67, p<0.01.
MP leads to improvement in team-based skills compared to traditional simulation-based trauma instruction. We feel that MP may be a useful and inexpensive tool for improving nontechnical skills instruction effectiveness for team-based trauma care.
有效的创伤复苏需要跨学科团队的协同努力。心理练习（MP）被定义为在无明显肌肉运动的情况下对活动进行心理演练，并且已被证明能提高技术和程序技能的掌握。心理练习在促进创伤相关的非技术、团队协作技能方面的作用尚未得到研究。
我们将麻醉学、急诊医学和外科学住院医师随机分成两人一组，再将这些小组随机分配到心理练习组或对照组。心理练习组进行20分钟的心理练习，对照组接受20分钟的高级创伤生命支持（ATLS）培训。然后，所有小组参与一次高保真模拟成人创伤复苏，并接受关于沟通、领导能力和团队协作的总结汇报。两名盲评人员使用梅奥高效团队协作量表（MHPTS，一种经过验证的基于团队的行为评定量表）对模拟复苏的视频记录进行独立评分。采用曼-惠特尼U检验评估组间差异。
78名住院医师提供了知情书面同意并被招募。使用MHPTS评估，心理练习组在团队协作行为方面的表现优于对照组，差异具有统计学意义：r = 0.67，p < 0.01。
与传统的基于模拟的创伤教学相比，心理练习能提高基于团队的技能。我们认为心理练习可能是一种有用且经济的工具，可提高基于团队的创伤护理中非技术技能教学的有效性。
